- Outpatient Services for Registered Inpatients
- Using the IVR to Avoid Eligibility and Entitlement-Related Claim Rejections and RTPs
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
- Annual Wellness Visits ‑ Billing Tips for Physicians
- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
- Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
- Billing for Drug Wastage: JW and JZ Modifier
- Billing Medicare for a Denial - Condition Code 21
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Billing Medicare Part A When VA-Eligible Medicare Beneficiaries Receive Services in Non VA Facilities
- Condition Code G0 Reminder
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Electronically Submitted Claims that Exceed $99,999.99
- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities
- Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
- Nonphysician Practitioners Billing for Surgical Procedures
- Professional Services During a Patient Hospice Election
- Professional Services During a Patient Hospice Election
- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
- Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims
Federally Qualified Health Centers Contracting with Medicare Advantage Plans
Requirements to Receive Wrap-Around Payments from Medicare
- The FQHC must have a written contract with the Medicare Advantage (MA) plan that contain the terms specified by Title 42 of the CFR, Section 422.527.
The contract must be signed by both the FQHC and the MA plan. A contract with an individual physician would not qualify for the supplemental payment. The person signing for the FQHC must be a representative of the FQHC.
FQHCs must provide the MAC with a valid MA contractor number with each contract. If they cannot, they will not be set up for the supplemental payment. To obtain the MA contractor number the FQHC should contact the MA plan manager.
- The FQHC must provide the MAC with an average MA per-visit payment rate for each MA plan they are under contract with.
If the MA rate is not contracted as a per-visit rate, FQHCs will need to convert fee schedules and/or capitation amounts to a per-visit. The MA rate must be accompanied by documentation of how the rate was calculated.
- A copy of the signed contract and the average MA per-visit payment rate should be sent to the following contact. This is for the WI workload and any main providers under the WI workload and you receive an inquiry from an FQHC satellite site.
John Stoll, Manager, Provider Audit & Reimbursement
National Government Services, Inc.
6775 West Washington Street
Milwaukee, WI 53203-2804
Fax number: 414-459-2828
Email: John.Stoll@wellpoint.com
- A copy of the signed contract and the average MA per-visit payment rate should be sent to the following contact for the Illinois workload (00131):
Pam Chelf, CPA, Manager, Medicare Audit and Reimbursement
8115 Knue Road
Mailpoint INA101-AF41
P.O. Box 7191
Indianapolis, IN 46250-7191
Fax number: 317-841-4436
- A copy of the signed contract and the average MA per-visit payment rate should be sent to the following contact for the JK workload:
Sandra J. O'Connor- JK Workload, Manager, Audit & Reimbursement
National Government Services, Inc.
P.O. Box 4900
Syracuse, NY 13221-4900
Phone: 315-442-4986
Fax number: 315-442-4551
Email: Sandra.O'connor@wellpoint.com